Introduction: Patients with PAD particularly compared to patients with other arteriosclerotic diseases (CVD, CHD), seem to be secondary preventive undersupplied. The aim was to examine the quality of drug-treated therapy in outpatient and inpatient areas considering current guidelines.
Methods: The prescription rate of secondary preventive medication was determined retrospectively for 257 PAD patients (47% women, 53% men, age ~ 70 ± 10 years) who were treated at least twice inpatient with a distance of at least 6 month between 2003 and 2010 in a vascular center in Berlin not considering the reasons for admission. Additional analyses of subgroups were performed (arterial hypertension, diabetes mellitus, hyperlipoproteinemia, cvd or chd, intervention).
Results: An antihypertensive therapy at first admission for ACE-inhibitors could be found for 48%. The prescription rate at second discharge increased to 66% (p < 0.001). For outpatient treatment the rate decreased significantly. Blood pressure values were constantly in normal range. 52% were given a statin at first admission. At second discharge the prescription rate was considerably increased (78%). In each case inpatient treatment was intensified significantly. Between hospitalizations the prescription rate decreased significantly in the outpatient area (p < 0.01). The mean LDL values exceeded the recommended limiting values by far. At admission only 80% received antithrombotics and anticoagulants (ATA), respectively. Until the second discharge the prescription rate increased to 95% (p < 0,001). The antidiabetic therapy was consistent and mean HbA1c values were in normal range. Patients with arteriosclerotic co-morbidities (cerebral/cardial) initially had significantly higher prescription rates than patients without these co-morbidities (ACE-inhibitor 57% vs. 33%; statin 59% vs. 39%; ATA 85% vs. 69% (each p < 0.001). Inpatient the rates increased in both groups (p < 0.05). In the outpatient area prescriptions for patients without accompanying CHD/ CVD were often canceled against explicit recommendations and guidelines (p < 0.05). That shows that patients with PAD alone do not receive appropriate treatment by non-dedicated colleagues in the outpatient area. Interventions also led to intensification of therapy between admission and discharge (e. g. ACE-inhibitor 44% vs. 63% (p < 0.005), statin 37% vs. 76% (p < 0.001), ATA 67% vs. 99% (p < 0.001)).
Conclusion: Observing the guidelines PAD patients are particularly undersupplied in the outpatient area. Inpatient hospitalizations in a specialized clinic lead to an intensification of therapy that, unfortunately, is discontinued for high risk patients. Thus, improving the training of patients and treating colleagues is urgently required.